Nevada health-care sign-up numbers disappoint, but optimism persists

It’s time to look ahead.

That was the sentiment Thursday, three days after the state exchange Nevada Health Link website wrapped its first open-enrollment session.

The exchange didn’t meet anyone’s expectations — not even those of exchange officials — but the insurance industry sounded hopeful that the marketplace’s issues could be patched before fall’s enrollment period.

The final sign-up stats, as well as a big, last-minute website error that may have hurt enrollments Sunday and Monday, made it clear the system needs help in the offseason.

The exchange reported 41,823 plan selections and 25,899 paid sign-ups from Oct. 1 to Monday. Consumers aren’t considered enrolled until they’ve actually paid, and they have until April 15 to do so. By Thursday afternoon, paid enrollments had jumped to about 28,000, exchange spokesman CJ Bawden said.

Still, that paid enrollment barely outweighs the 25,000 Nevadans who had plans canceled last fall because they didn’t meet Obamacare’s new coverage mandates. It’s also a fraction of the 118,000 new members the exchange and website contractor Xerox forecasted. And it pales next to the 139,442 people who submitted Medicaid applications.

Bawden said the exchange didn’t track how many people who bought plans were covered before. The system did look at enrollment by age, though. It found that ages 55 to 64 made up the biggest group of members, at 31 percent. The second-largest group was consumers ages 18 to 34, at 21 percent.

Many insurance professionals said they also fell short of sign-up goals.

The Nevada Health CO-OP, a nonprofit insurance carrier created by the Affordable Care Act, projected 30,000 new members in its first year; by the weekend, it had reached 10,200 paid customers, with another 7,000 pending as unpaid.

CEO Tom Zumtobel said he thinks as many as 5,000 of those pending members will become paid enrollees. That would put the group at 15,000.

“We can sure work with that. That would be a decent base, and great as far as spreading our administrative costs,” Zumtobel said.

Zumtobel said he was also pleased that the CO-OP snagged 37 percent of exchange enrollments, nearly double the 20 percent it expected — a market share he attributed to the insurer’s competitive pricing, walk-in customer-service centers and community outreach.


Insurance broker Vickie Mayville, president of the Nevada Association of Health Underwriters, said the first enrollment session failed to live up to her expectations. Mayville said she thought she could sign up 100 consumers in the six-month period, but she managed to enroll just 12.

“I had high hopes. I went to all of the (exchange) board meetings. I knew it was going to be difficult because new technology always is when you first start out,” Mayville said. “But I thought it would work much better than it did. And to have it be plagued with errors to the very end, it blows my mind. I can’t believe how bad it was. It was really bad.”

One major error that hit over the weekend was a software flaw that accidentally shut down enrollments early.

Carriers and brokers reported a message at 5 p.m. Sunday, and 5 a.m. Monday, that said open enrollment had ended. It wasn’t scheduled to end until midnight Tuesday.

Zumtobel said the CO-OP was in the middle of an enrollment fair at a church Sunday night when the website shut down.

“It took us eight hours to get it fixed,” said Zumtobel, who said he called Gov. Brian Sandoval’s office to get Xerox to repair the issue. “We couldn’t enroll anyone. We had to shut off our emails and take paper applications.”

The glitch was the latest website hiccup that gave enrollees fits. Xerox cited 182 patches it was working on in February — and that was just the “high-priority” count.

That’s partly why the exchange scheduled a special-enrollment period that began Tuesday and runs through May 30. Bawden said consumers who qualify for special enrollment include 89,200 people who made it through eligibility determination but never picked a plan. Include people who couldn’t make it through the process because of website issues, and the number is well over 100,000. But the exchange will focus its efforts on the 15,000 or so consumers who have selected plans but not paid.

Special enrollees were “starting to trickle in” Thursday, Bawden said.

Insurers and brokers said they hope to help convert those potential members into actual enrollees.

Zumtobel said he believes the CO-OP may get another 2,000 to 3,000 members through special enrollment.

Exchange staff and insurance professionals are looking beyond May, too.

The exchange board is scheduled to receive a report in the next four weeks from contractor Deloitte Consulting about what the system needs to upgrade to ensure technical problems and low enrollments don’t repeat when the next open-enrollment period kicks off Nov. 15.

Bawden said the exchange will concentrate strictly this summer on improving Nevada Health Link’s website.

One goal is to have a pre-launch website in mid-October on which consumers can pre-enter their information. When Nov. 15 comes, they will be able to select a plan, put it in their cart and pay, Bawden said.

“We want to see Nevadans access a fully functional system with no errors, and be able to come through no matter how many Nevadans are on the site at the same time,” he said. “We want a seamless customer experience so they can shop for, select and purchase health insurance plans, apply for an advance premium tax credit and go through the checkout process with ease.”


The biggest change Zumtobel would recommend? Making the website easier to understand for consumers.

The site needs to do a better job of letting people compare plans, he said. The exchange put plan deductibles in a prominent position, but deductibles aren’t everything: Some apply only to hospital stays, and not to routine doctor visits, Zumtobel said.

“Absolutely the most important thing is that it has to have more of a consumer orientation,” he said. “Screens have to be more consumer-friendly, and it has to be quicker. It just can’t be this complicated and take this long.”

Also, once special enrollment is over, insurers will have to file their 2015 plans and premiums with the Insurance Division, which will then have to vet the policies for fair pricing and adequate provider networks.

Once the official rates on the new plans go public — probably sometime in September — the exchange, insurers and brokers will be in the last few weeks of preparations for November’s sign-ups.

Observers say they hope for success.

Mayville said some insurance brokers are so frustrated by the system’s issues that they plan to sit out the November relaunch.

But she said she will be back at it.

“I like to help people. I hope the website will run better next (session),” she said.

Zumtobel said for all its flaws, the exchange worked at letting consumers compare plans, and at fostering healthy competition among insurers.

“I’m so hopeful the exchange survives. I think the exchange is at risk. I think there’s a chance that leadership or whoever might believe this exchange was so complicated that we need to give people alternatives like going directly to carriers to enroll. It sounds like the right thing to do, but it would eliminate the strength of competition.

“We really want that shopping experience to be preserved, and we’re going to fight to help preserve it.”

Contact reporter Jennifer Robison at jrobison@reviewjournal.com or 702-380-4512. Follow @J_Robison1 on Twitter.


THE NUMBERS: Nevada Health Link posted 25,899 paid enrollments from Oct. 1 to Monday, the deadline for open enrollment. It had 41,823 consumers choose a qualified health plan. Another 139,442 Nevadans submitted applications for Medicaid coverage.

DEMOGRAPHICS: Nevadans ages 55 to 64 made up the biggest group of members, at 31 percent. The second-largest group was consumers ages 18 to 34, at 21 percent.

SPECIAL ENROLLMENT: Consumers who couldn’t finish enrollment by Monday get an extension through a special-enrollment period that runs until May 30. People who qualify include 89,200 who made it through eligibility determination, but never picked a plan. The number is well over 100,000 if you include consumers who couldn’t make it to eligibility determination. The exchange will focus on the 15,000 consumers who selected plans but have not paid.

WHAT’S COMING: Nevada Health Link officials say they’ll be ready for the next open-enrollment period from Nov. 15 through Feb. 15. They’ll concentrate on straightening out website glitches that hobbled enrollments in the first session.